Analysis of the interaction between bolt-reinforced rock and surface support in tunnels based on convergence-confinement method

To investigate the interaction of the bolt-reinforced rock and the surface support,an analytical model of the convergence-confinement type is proposed,considering the sequential installation of the fully grouted rockbolts and the surface support.The rock mass is assumed to be elastic-brittle-plastic material,obeying the linear Mohr-Coulomb criterion or the non-linear Hoek-Brown criterion.According to the strain states of the tunnel wall at bolt and surface support installation and the relative magnitude between the bolt length and the plastic depth during the whole process,six cases are categorized upon solving the problem.Each case is divided into three stages due to the different effects of the active rockbolts and the passive surface support.The fictitious pressure is introduced to quantify the threedimensional(3D)effect of the tunnel face,and thus,the actual physical location along the tunnel axis of the analytical section can be considered.By using the bolt-rock strain compatibility and the rocksurface support displacement compatibility conditions,the solutions of longitudinal tunnel displacement and the reaction pressure of surface support along the tunnel axis are obtained.The proposed analytical solutions are validated by a series of 3D numerical simulations.Extensive parametric studies are conducted to examine the effect of the typical parameters of rockbolts and surface support on the tunnel displacement and the reaction pressure of the surface support under different rock conditions.The results show that the rockbolts are more effective in controlling the tunnel displacement than the surface support,which should be installed as soon as possible with a suitable length.For tunnels excavated in weak rocks or with restricted displacement control requirements,the surface support should also be installed or closed timely with a certain stiffness.The proposed method provides a convenient alternative approach for the optimization of rockbolts and surface support at the preliminary stage of tunnel design.

Semi-analytical investigation of heat transfer in a porous convective radiative moving longitudinal fin exposed to magnetic field in the presence of a shape-dependent trihybrid nanofluid

The thermal examination of a non-integer-ordered mobile fin with a magnetism in the presence of a trihybrid nanofluid(Fe_3O_4-Au-Zn-blood) is carried out. Three types of nanoparticles, each having a different shape, are considered. These shapes include spherical(Fe_3O_4), cylindrical(Au), and platelet(Zn) configurations. The combination approach is utilized to evaluate the physical and thermal characteristics of the trihybrid and hybrid nanofluids, excluding the thermal conductivity and dynamic viscosity. These two properties are inferred by means of the interpolation method based on the volume fraction of nanoparticles. The governing equation is transformed into a dimensionless form, and the Adomian decomposition Sumudu transform method(ADSTM) is adopted to solve the conundrum of a moving fin immersed in a trihybrid nanofluid. The obtained results agree well with those numerical simulation results, indicating that this research is reliable. The influence of diverse factors on the thermal overview for varying noninteger values of γ is analyzed and presented in graphical representations. Furthermore, the fluctuations in the heat transfer concerning the pertinent parameters are studied. The results show that the heat flux in the presence of the combination of spherical, cylindrical, and platelet nanoparticles is higher than that in the presence of the combination of only spherical and cylindrical nanoparticles. The temperature at the fin tip increases by 0.705 759% when the value of the Peclet number increases by 400%, while decreases by 11.825 13% when the value of the Hartman number increases by 400%.

Generation of structured light beams with polarization variation along arbitrary spatial trajectories using tri-layer metasurfaces

Conventionally,the spatially structured light beams produced by metasurfaces primarily highlight the polarization modulation of the beams propagating along the optical axis or the beams'spatial transmission trajectory.In particular,along the optical axis,the polarization state is either constant or varies continuously in each output plane.Here,we develop innovative spatially structured light beams with continually changing polarization along any arbitrary spatial transmission trajectories.With tri-layer metallic metasurfaces,the geometric characteristics of each layer structure can be adjusted to modulate the phase and polarization state of the incident terahertz(THz)wave.The beam will converge to the predefined trajectory along several paths to generate a Bessel-like beam with longitudinal polarization changes.We demonstrate the versatility of the approach by designing two THz-band structured light beams with varying polarization states along the spatial helical transmission trajectory.Continuous linear polarization changes and linear polarization to right circular polarization(RCP)and back to linear polarization changes are realized respectively.The experimental results are basically consistent with the simulated results.Our proposal for arbitrary trajectory structured light beams with longitudinally varying polarization offers a practical method for continuously regulating the characteristics of spatial structured light beams with non-axial transmission.This technique has potential uses in optical encryption,particle manipulation,and biomedical imaging.

Improving the utility of locally differentially private protocols for longitudinal and multidimensional frequency estimates

This paper investigates the problem of collecting multidimensional data throughout time(i.e.,longitudinal studies)for the fundamental task of frequency estimation under Local Differential Privacy(LDP)guarantees.Contrary to frequency estimation of a single attribute,the multidimensional aspect demands particular attention to the privacy budget.Besides,when collecting user statistics longitudinally,privacy progressively degrades.Indeed,the“multiple”settings in combination(i.e.,many attributes and several collections throughout time)impose several challenges,for which this paper proposes the first solution for frequency estimates under LDP.To tackle these issues,we extend the analysis of three state-of-the-art LDP protocols(Generalized Randomized Response–GRR,Optimized Unary Encoding–OUE,and Symmetric Unary Encoding–SUE)for both longitudinal and multidimensional data collections.While the known literature uses OUE and SUE for two rounds of sanitization(a.k.a.memoization),i.e.,L-OUE and L-SUE,respectively,we analytically and experimentally show that starting with OUE and then with SUE provides higher data utility(i.e.,L-OSUE).Also,for attributes with small domain sizes,we propose Longitudinal GRR(L-GRR),which provides higher utility than the other protocols based on unary encoding.Last,we also propose a new solution named Adaptive LDP for LOngitudinal and Multidimensional FREquency Estimates(ALLOMFREE),which randomly samples a single attribute to be sent with the whole privacy budget and adaptively selects the optimal protocol,i.e.,either L-GRR or L-OSUE.As shown in the results,ALLOMFREE consistently and considerably outperforms the state-of-the-art L-SUE and L-OUE protocols in the quality of the frequency estimates.

Characteristic analysis of 1.06μm long-cavity diode lasers based on asymmetric waveguide structures

In long-cavity edge-emitting diode lasers,longitudinal spatial hole burning(LSHB),two-photon ab⁃sorption(TPA)and free carrier absorption(FCA)are among the key factors that affect the linear increase in out⁃put power at high injection currents.In this paper,a simplified numerical analysis model is proposed for 1.06μm long-cavity diode lasers by combining TPA and FCA losses with one-dimensional(1D)rate equations.The ef⁃fects of LSHB,TPA and FCA on the output characteristics are systematically analyzed,and it is proposed that ad⁃justing the front facet reflectivity and the position of the quantum well(QW)in the waveguide layer can improve the front facet output power.

Bunch-length measurement at a bunch-by-bunch rate based on time–frequency-domain joint analysis techniques and its application

This paper presents a new technique for measuring the bunch length of a high-energy electron beam at a bunch-by-bunch rate in storage rings.This technique uses the time–frequency-domain joint analysis of the bunch signal to obtain bunch-by-bunch and turn-by-turn longitudinal parameters,such as bunch length and synchronous phase.The bunch signal is obtained using a button electrode with a bandwidth of several gigahertz.The data acquisition device was a high-speed digital oscilloscope with a sampling rate of more than 10 GS/s,and the single-shot sampling data buffer covered thousands of turns.The bunch-length and synchronous phase information were extracted via offline calculations using Python scripts.The calibration coefficient of the system was determined using a commercial streak camera.Moreover,this technique was tested on two different storage rings and successfully captured various longitudinal transient processes during the harmonic cavity debugging process at the Shanghai Synchrotron Radiation Facility(SSRF),and longitudinal instabilities were observed during the single-bunch accumulation process at Hefei Light Source(HLS).For Gaussian-distribution bunches,the uncertainty of the bunch phase obtained using this technique was better than 0.2 ps,and the bunch-length uncertainty was better than 1 ps.The dynamic range exceeded 10 ms.This technology is a powerful and versatile beam diagnostic tool that can be conveniently deployed in high-energy electron storage rings.

Structural and functional connectivity of the whole brain and subnetworks in individuals with mild traumatic brain injury:predictors of patient prognosis

Patients with mild traumatic brain injury have a diverse clinical presentation,and the underlying pathophysiology remains poorly understood.Magnetic resonance imaging is a non-invasive technique that has been widely utilized to investigate neuro biological markers after mild traumatic brain injury.This approach has emerged as a promising tool for investigating the pathogenesis of mild traumatic brain injury.G raph theory is a quantitative method of analyzing complex networks that has been widely used to study changes in brain structure and function.However,most previous mild traumatic brain injury studies using graph theory have focused on specific populations,with limited exploration of simultaneous abnormalities in structural and functional connectivity.Given that mild traumatic brain injury is the most common type of traumatic brain injury encounte red in clinical practice,further investigation of the patient characteristics and evolution of structural and functional connectivity is critical.In the present study,we explored whether abnormal structural and functional connectivity in the acute phase could serve as indicators of longitudinal changes in imaging data and cognitive function in patients with mild traumatic brain injury.In this longitudinal study,we enrolled 46 patients with mild traumatic brain injury who were assessed within 2 wee ks of injury,as well as 36 healthy controls.Resting-state functional magnetic resonance imaging and diffusion-weighted imaging data were acquired for graph theoretical network analysis.In the acute phase,patients with mild traumatic brain injury demonstrated reduced structural connectivity in the dorsal attention network.More than 3 months of followup data revealed signs of recovery in structural and functional connectivity,as well as cognitive function,in 22 out of the 46 patients.Furthermore,better cognitive function was associated with more efficient networks.Finally,our data indicated that small-worldness in the acute stage could serve as a predictor of longitudinal changes in connectivity in patients with mild traumatic brain injury.These findings highlight the importance of integrating structural and functional connectivity in unde rstanding the occurrence and evolution of mild traumatic brain injury.Additionally,exploratory analysis based on subnetworks could serve a predictive function in the prognosis of patients with mild traumatic brain injury.

Longitudinal vibration characteristics of a tapered pipe pile considering the vertical support of surrounding soil and construction disturbance

This research is concentrated on the longitudinal vibration of a tapered pipe pile considering the vertical support of the surrounding soil and construction disturbance.First,the pile-soil system is partitioned into finite segments in the vertical direction and the Voigt model is applied to simulate the vertical support of the surrounding soil acting on the pile segment.The surrounding soil is divided into finite ring-shaped zones in the radial direction to consider the construction disturbance.Then,the shear complex stiffness at the pile-soil interface is derived by solving the dynamic equilibrium equation for the soil from the outermost to innermost zone.The displacement impedance at the top of an arbitrary pile segment is obtained by solving the dynamic equilibrium equation for the pile and is combined with the vertical support of the surrounding soil to derive the displacement impedance at the bottom of the upper adjacent segment.Further,the displacement impedance at the pile head is obtained based on the impedance function transfer technique.Finally,the reliability of the proposed solution is verified,followed by a sensitivity analysis concerning the coupling effect of the pile parameters,construction disturbance and the vertical support of the surrounding soil on the displacement impedance of the pile.

Research on the longitudinal protection of a through-type cophase traction direct power supply system based on the empirical wavelet transform

This paper proposes a longitudinal protection scheme utilizing empirical wavelet transform(EWT)for a through-type cophase traction direct power supply system,where both sides of a traction network line exhibit a distinctive boundary structure.This approach capitalizes on the boundary’s capacity to attenuate the high-frequency component of fault signals,resulting in a variation in the high-frequency transient energy ratio when faults occur inside or outside the line.During internal line faults,the high-frequency transient energy at the checkpoints located at both ends surpasses that of its neighboring lines.Conversely,for faults external to the line,the energy is lower compared to adjacent lines.EWT is employed to decompose the collected fault current signals,allowing access to the high-frequency transient energy.The longitudinal protection for the traction network line is established based on disparities between both ends of the traction network line and the high-frequency transient energy on either side of the boundary.Moreover,simulation verification through experimental results demonstrates the effectiveness of the proposed protection scheme across various initial fault angles,distances to faults,and fault transition resistances.

Transverse mode-coupling instability with longitudinal impedance

Transverse mode-coupling instability(TMCI)is a dangerous transverse single-bunch instability that can lead to severe par-ticle loss.The mechanism of TMCI can be explained by the coupling of transverse coherent oscillation modes owing to the transverse short-range wakefield(i.e.,the transverse broadband impedance).Recent studies on future circular colliders,e.g.,FCC-ee,showed that the threshold of TMCI decreased significantly when both longitudinal and transverse impedances were included.We performed computations for the circular electron-positron collider(CEPC)and observed a similar phenom-enon.Systematic studies on the influence of longitudinal impedance on the TMCI threshold were conducted.We concluded that the imaginary part of the longitudinal impedance,which caused a reduction in the incoherent synchrotron tune,was the primary reason for the reduction in the TMCI threshold.Additionally,the real part of the longitudinal impedance assists in increasing the TMCI threshold.

DAPK2 promotes autophagy to accelerate the progression of ossification of the posterior longitudinal ligament through the mTORC1 complex

Background:Ossification of the posterior longitudinal ligament(OPLL)is a prevalent condition in orthopedics.While death-associated protein kinase 2(DAPK2)is known to play roles in cellular apoptosis and autophagy,its specific contributions to the advancement of OPLL are not well understood.Methods:Ligament fibroblasts were harvested from patients diagnosed with OPLL.Techniques such as real-time reverse transcriptasepolymerase chain reaction(RT-qPCR)and Western blot analysis were employed to assess DAPK2 levels in both ligament tissues and cultured fibroblasts.The extent of osteogenic differentiation in these cells was evaluated using an alizarin red S(ARS)staining.Additionally,the expression of ossification markers and autophagy markers was quantified.The autophagic activity was further analyzed through LC3 immunofluorescence and transmission electron microscopy(TEM).An in vivo heterotopic bone formation assay was conducted in mice to assess the role of DAPK2 in ossification.Results:Elevated DAPK2 expression was confirmed in both OPLL patient tissues and derived fibroblasts,in contrast to non-OPLL controls.Silencing of DAPK2 significantly curtailed osteogenic differentiation and autophagy in these fibroblasts,evidenced by decreased levels of LC3,and Beclin1,and reduced autophagosome formation.Additionally,DAPK2 was found to inhibit the mechanistic target of the rapamycin complex 1(mTORC1)complex’s activity.In vivo studies demonstrated that DAPK2 facilitates ossification,and this effect could be counteracted by the mTORC1 inhibitor rapamycin.Conclusion:DAPK2 enhances autophagy and osteogenic processes in OPLL through modulation of the mTORC1 pathway.

Relationship between longitudinal changes in lipid composition and ischemic stroke among hypertensive patients

BACKGROUND Dyslipidemia was strongly linked to stroke,however the relationship between dyslipidemia and its components and ischemic stroke remained unexplained.AIM To investigate the link between longitudinal changes in lipid profiles and dyslipidemia and ischemic stroke in a hypertensive population.METHODS Between 2013 and 2014,6094 hypertension individuals were included in this,and ischemic stroke cases were documented to the end of 2018.Longitudinal changes of lipid were stratified into four groups:(1)Normal was transformed into normal group;(2)Abnormal was transformed into normal group;(3)Normal was transformed into abnormal group;and(4)Abnormal was transformed into abnormal group.To examine the link between longitudinal changes in dyslipidemia along with its components and the risk of ischemic stroke,we utilized multivariate Cox proportional hazards models with hazard ratio(HR)and 95%CI.RESULTS The average age of the participants was 62.32 years±13.00 years,with 329 women making up 54.0%of the sample.Over the course of a mean follow-up of 4.8 years,143 ischemic strokes happened.When normal was transformed into normal group was used as a reference,after full adjustments,the HR for dyslipidemia and ischemic stroke among abnormal was transformed into normal group,normal was transformed into abnormal group and abnormal was transformed into abnormal Wei CC et al.Dyslipidemia changed and ischemic stroke WJCC https://www.wjgnet.com 2 February 6,2025 Volume 13 Issue 4 group were 1.089(95%CI:0.598-1.982;P=0.779),2.369(95%CI:1.424-3.941;P<0.001)and 1.448(95%CI:1.002-2.298;P=0.047)(P for trend was 0.233),respectively.CONCLUSION In individuals with hypertension,longitudinal shifts from normal to abnormal in dyslipidemia-particularly in total and low-density lipoprotein cholesterol-were significantly associated with the risk of ischemic stroke.

Recent Construction Technology Innovations and Practices for Large-Span Arch Bridges in China

Arch bridges provide significant technical and economic benefits under suitable conditions.In particular,concrete-filled steel tubular(CFST)arch bridges and steel-reinforced concrete(SRC)arch bridges are two types of arch bridges that have gained great economic competitiveness and span growth potential due to advancements in construction technology,engineering materials,and construction equipment over the past 30 years.Under the leadership of the author,two record-breaking arch bridges—that is,the Pingnan Third Bridge(a CFST arch bridge),with a span of 560 m,and the Tian’e Longtan Bridge(an SRC arch bridge),with a span of 600 m—have been built in the past five years,embodying great technological breakthroughs in the construction of these two types of arch bridges.This paper takes these two arch bridges as examples to systematically summarize the latest technological innovations and practices in the construction of CFST arch bridges and SRC arch bridges in China.The technological innovations of CFST arch bridges include cable-stayed fastening-hanging cantilevered assembly methods,new in-tube concrete materials,in-tube concrete pouring techniques,a novel thrust abutment foundation for nonrocky terrain,and measures to reduce the quantity of temporary facilities.The technological innovations of SRC arch bridges involve arch skeleton stiffness selection,the development of encasing concrete materials,encasing concrete pouring,arch rib stress mitigation,and longitudinal reinforcement optimization.To conclude,future research focuses and development directions for these two types of arch bridges are proposed.

Parametric investigation of railway fastenings into the formation and mitigation of short pitch corrugation

Short pitch corrugation has been a problem for railways worldwide over one century.In this paper,a parametric investigation of fastenings is conducted to understand the corrugation formation mechanism and gain insights into corrugation mitigation.A three-dimensional finite element vehicle-track dynamic interaction model is employed,which considers the coupling between the structural dynamics and the contact mechanics,while the damage mechanism is assumed to be differential wear.Various fastening models with different configurations,boundary conditions,and parameters of stiffness and damping are built up and analysed.These models may represent different service stages of fastenings in the field.Besides,the effect of train speeds on corrugation features is studied.The results indicate:(1)Fastening parameters and modelling play an important role in corrugation formation.(2)The fastening longitudinal constraint to the rail is the major factor that determines the corrugation formation.The fastening vertical and lateral constraints influence corrugation features in terms of spatial distribution and wavelength components.(3)The strengthening of fastening constraints in the longitudinal dimension helps to mitigate corrugation.Meanwhile,the inner fastening constraint in the lateral direction is necessary for corrugation alleviation.(4)The increase in fastening longitudinal stiffness and damping can reduce the vibration amplitudes of longitudinal compression modes and thus reduce the track corrugation propensity.The simulation in this work can well explain the field corrugation in terms of the occurrence possibility and major wavelength components.It can also explain the field data with respect to the small variation between the corrugation wavelength and train speed,which is caused by frequency selection and jump between rail longitudinal compression modes.

Subclinical impairment of left ventricular myocardium function in type 2 diabetes mellitus patients with or without hypertension

BACKGROUND Cardiovascular disease has been the leading cause of morbidity and mortality for type 2 diabetes mellitus(T2DM)patients over the last decade.AIM To determine whether layer-specific global longitudinal strain(GLS)combined with peak strain dispersion(PSD)can be used to assess left ventricle(LV)myocardium systolic dysfunction in T2DM patients or without hypertension(HP).METHODS We enrolled 97 T2DM patients,70 T2DM+HP patients and 101 healthy subjects.Layer-specific GLS and PSD were calculated by EchoPAC software in apical three-,four-and two-chamber views.GLS of the epimyocardial,middle-layer and endomyocardial(GLSepi,GLSmid,and GLSendo)were measured and recorded.Receiver operating characteristic analysis was performed to detect LV myocardium systolic dysfunction in T2DM patients.RESULTS There were significant differences in GLSepi,GLSmid,GLSendo,and PSD between healthy subjects,T2DM patients and T2DM patients with HP(P<0.001).Trend tests yielded the ranking of healthy subjects>T2DM patients>T2DM with HP patients in the absolute values of GLSepi,GLSmid and GLSendo(P<0.001),while PSD was ranked healthy subjects<T2DM<T2DM with HP(P<0.001).Layer-specific GLS and PSD had high diagnostic efficiency for detecting LV myocardium systolic dysfunction in T2DM patients,however,the area under the curve(AUC)for layer-specific GLS and PSD combined was significantly higher than the AUCs for the individual indices(P<0.05).CONCLUSION Layer-specific GLS and PSD were associated with LV myocardium systolic dysfunction in T2DM patients,T2DM patients with HP.T2DM patients with HP have more severe LV myocardium systolic dysfunction than T2DM patients without HP and normal control patients.The combination of layer-specific GLS and PSD may provide additional prognostic information for T2DM patients with or without HP.

Factor Structure and Longitudinal Invariance of the CES-D across Diverse Residential Backgrounds in Chinese Adolescents

Background:Valid and reliable measures of depressive symptoms are crucial for understanding risk factors,outcomes,and interventions across rural and urban settings.Despite this need,the longitudinal invariance of these measures over time remains understudied.This research explores the structural components of the Center for Epidemiological Studies Depression Scale(CES-D)and examines its consistency across various living environments and temporal stability in a cohort of Chinese teenagers.Method:In the initial phase,1,042 adolescents furnished demographic details and undertook the CES-D assessment.After a three-month interval,967 of these participants repeated the CES-D evaluation.The study employed Confirmatory factor analysis(CFA)to scrutinize the scale’s structural integrity.We investigated factorial invariance by conducting a twopronged CFA:one comparing urban vs.rural backgrounds,and another contrasting the results from the initial assessment with those from the follow-up.Results:The CES-D demonstrated adequate reliability in both rural and urban high school student samples.The preliminary four-factor model applied to the CES-D demonstrated a good fit with the collected data.Invariance tests,including multigroup analyses comparing rural and urban samples and longitudinal assessments,confirmed the scale’s invariance.Conclusions:The results suggest that the CES-D serves as a reliable instrument for evaluating depressive symptoms among Chinese adolescents.Its applicability is consistent across different living environments and remains stable over time.

Changes in postoperative depression and anxiety and their relationship with recovery from femoral head necrosis:A longitudinal study

BACKGROUND Femoral head necrosis(FHN)can significantly affect patients'psychological well-being and functional outcomes.However,the long-term relationship between postoperative depression,anxiety,and functional recovery in patients with FHN remains unclear.AIM To investigate the dynamic changes in postoperative depression and anxiety and their relationship with functional recovery in patients with FHN for 3 years.METHODS Ninety-three patients with FHN who underwent surgical treatment in March 2020 to 2023 were enrolled in this longitudinal study.Depression and anxiety status were assessed using the hospital anxiety and depression scale(HADS)at baseline,6 months,1,2,and 3 years postoperatively.Functional recovery was evaluated using the Harris hip score(HHS).The dynamic changes in HADS and HHS were analyzed using repeated measures ANOVA;the relationship between depre-ssion/anxiety status and functional recovery was examined using Pearson’s correlation analysis.RESULTS The mean HADS-depression(HADS-D)and HADS-anxiety(HADS-A)scores significantly improved over time(P<0.001).The prevalence of depression and anxiety decreased from 36.6%and 41.9%at baseline to 10.8%and 12.9%,respectively,at 3 years postoperatively.The mean HHS increased sig-nificantly from 52.3±10.5 at baseline to 88.1±7.2 at 3 years postoperatively(P<0.001).Significant negative correl-ations were found between HADS-D/HADS-A scores and HHS at all time points(P<0.05).CONCLUSION The severity of depression and anxiety negatively correlated with functional recovery,highlighting the importance of psychological interventions in the management of patients with FHN.

Distribution Line Longitudinal ProtectionMethod Based on Virtual Measurement Current Restraint

As an effective approach to achieve the“dual-carbon”goal,the grid-connected capacity of renewable energy increases constantly.Photovoltaics are the most widely used renewable energy sources and have been applied on various occasions.However,the inherent randomness,intermittency,and weak support of grid-connected equipment not only cause changes in the original flow characteristics of the grid but also result in complex fault characteristics.Traditional overcurrent and differential protection methods cannot respond accurately due to the effects of unknown renewable energy sources.Therefore,a longitudinal protection method based on virtual measurement of current restraint is proposed in this paper.The positive sequence current data and the network parameters are used to calculate the virtual measurement current which compensates for the output current of photovoltaic(PV).The waveform difference between the virtual measured current and the terminal current for internal and external faults is used to construct the protection method.An improved edit distance algorithm is proposed to measure the similarity between virtual measurement current and terminal measurement current.Finally,the feasibility of the protection method is verified through PSCAD simulation.

Evaluation of left ventricular systolic function in type 2 diabetes mellitus patients with and without peripheral vascular disease

BACKGROUND Peripheral vascular disease(PVD)is a common complication of type 2 diabetes mellitus(T2DM).Patients with T2DM have twice the risk of PVD as nondiabetic patients.AIM To evaluate left ventricular(LV)systolic function by layer-specific global longitudinal strain(GLS)and peak strain dispersion(PSD)in T2DM patients with and without PVD.METHODS Sixty-five T2DM patients without PVD,57 T2DM patients with PVD and 63 normal controls were enrolled in the study.Layer-specific GLS[GLS of the epimyocardium(GLSepi),GLS of the middle myocardium(GLSmid)and GLS of the endocardium(GLSendo)]and PSD were calculated.Receiver operating characteristic(ROC)analysis was performed to calculate the sensitivity and specificity of LV systolic dysfunction in T2DM patients with PVD.We calculated Pearson’s correlation coefficients between biochemical data,echocardiographic characteristics,and layer-specific GLS and PSD.RESULTS There were significant differences in GLSepi,GLSmid and GLSendo between normal controls,T2DM patients without PVD and T2DM patients with PVD(P<0.001).Trend tests revealed a ranking of normal controls>T2DM patients without PVD>T2DM patients with PVD in the absolute value of GLS(P<0.001).PSD differed significantly between the three groups,and the trend ranking was as follows:normal controls<T2DM patients without PVD<T2DM patients with PVD(P<0.001).ROC analysis revealed that the combination of layer-specific GLS and PSD had high diagnostic efficiency for detecting LV systolic dysfunction in T2DM patients with PVD.Lowdensity lipoprotein cholesterol was positively correlated with GLSepi,GLSmid and PSD(P<0.05),while LV ejection fraction was negatively correlated with GLSepi,GLSmid and GLSendo in T2DM patients with PVD(P<0.01).CONCLUSION PVD may aggravate the deterioration of LV systolic dysfunction in T2DM patients.Layer-specific GLS and PSD can be used to detect LV systolic dysfunction accurately and conveniently in T2DM patients with or without PVD.

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.